Undescended Testicles

Background

Undescended or ectopic testcles are testicles that are not found in the typical scrotal compartment. Often they are present in the groin, above the scrotum or in the abdomen. The incidence of undescended testicles has been found to be increasing and is approximately 3-4% for term babies. Pre-term babies have a higher incidence of undescended testicles.

Causes

The cause of undescended or ectopic testicles are not well-known. The cause is thought to be multifactorial which include genetic and environmental factors.

Diagnosis and Evaluation

Children are diagnosed by physical examination. Both testis should be palpable within the scrotal compartment.

The majority (70-80%) of children will have a palpable testis somewhere along the path of descent of the testis. 60-70% of patients have a unilateral undescended testicle. Of those where you cannot palpate a testis (i.e. a non-palbable testis), 50% of those patients will have an intrabdominal testis that has not descended, 40% will have an absent testis and 10% will have an ectopic testicle somewhere outside the typical path of descent of the testicle.

Occasionally an abdominal and scrotal ultrasound is ordered if the child is obese and difficult to examine or have bilateral undescended testicles.

Treatment

Testes can descend spontaneously within the first 6 months of life. Up to 80% of patients will have descent of the testicle spontaeously within the first 6 months of life. As a result, children will have serial examinations to check for testicular descent. After 6 months of life, testes are less likely to descend spontaneously and, as a result, most children will have a surgical repair between 1-2 years of life. The surgery for an undescended testicle is called an orchiopexy.

Orchiopexy is a surgery to bring testicle down to the scrotum. It is a daycare surgery that is completed under a general anaesthetic. Generally, an incision is made in the groin to free up the testicle from its aberrant attachments. A second incision is made in the scrotum to fix the testicle in place.

Risks of orchiopexy are small. The common risks are bleeding and infection (<5%). The risks specific to this procedure are injury to the spermatic cord which may include testicular atrophy (15%).

For children with non-palpable testes, because 50% of children will have a intra-abdominal testicle, they require an exploratory laproscopic surgery to check for an intra-abdominal testicle and for further surgical planning.

All children should have a post-operative visit and another visit to assess the testicles 6-12 months following the operation.

Are there risks of associated with undescended testicles?

The risks of infertility and testicular cancer associated with undescended testicles are small. As the majorty of children are repaired in infancy, these risks are decreased significantly by early repair.

Because the baseline risk of testicular cancer is mildly elevated, testicular self-examination should be performed in pubertal males. The relative risk of developing cancer in unrepaired undescended testicles is 2-8x's compared to the general population. This risk is reduced significantly by pre-pubertal surgical repair (orchiopexy) to 2-3x's the general population risk. The general population risk of testicular cancer is 0.4%. For patients who have had an pre-pubertal orchiopexy the risk of testicular cancer is 1-3%. This is significantly less than was thought historically.

AN ANNUAL TESTICULAR SELF-EXAMINATION SHOULD BE PERFORMED FOR ALL MALES ONCE THEY ENTER PUBERTY.